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Medical Authorization Form

Medical Record

To request a copy of your Medical Record from Providence Medical Center, print off the below form, and mail or fax that form along with a copy of your official state ID to 913-596-4461.

If you have questions, feel free to call us at 913-596-4178, Monday through Friday, 8 a.m. to 4:30 p.m.

Click here to obtain our Authorization For Release of Information Form.

Patient Portal

You may also visit the Patient Portal. If you have questions regarding the Patient Portal, please call 913-596-7241.